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O' Riordan A, Young DA, Ginty AT. Disordered eating is associated with blunted blood pressure reactivity and poorer habituation to acute psychological stress. Biol Psychol 2023; 179:108553. [PMID: 37028794 DOI: 10.1016/j.biopsycho.2023.108553] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/04/2022] [Revised: 04/03/2023] [Accepted: 04/05/2023] [Indexed: 04/09/2023]
Abstract
Psychological stress has been shown to influence the development and progression of disordered eating. Psychophysiological studies have reported that individuals with disordered eating behavior exhibit atypical cardiovascular reactions to acute psychological stress. However, prior studies have been limited by small sample sizes and have examined cardiovascular responses to a singular stress exposure. The current study examined the association between disordered eating and cardiovascular reactivity, as well as cardiovascular habituation to acute psychological stress. A mixed-sex sample (N = 450) of undergraduate students were categorized into a disordered eating or non-disordered eating group using a validated disordered eating screening questionnaire and attended a laboratory stress testing session. The testing session included two identical stress-testing protocols, each consisting of a 10-minute baseline and 4-minute stress task. Cardiovascular parameters including heart rate, systolic/diastolic blood pressure and mean arterial pressure (MAP) were recorded throughout the testing session. Post task measures of self-reported stress, as well as positive affect and negative affect (NA) reactivity were used to assess psychological reactions to stress. The disordered eating group exhibited greater increases in NA reactivity in response to both stress exposures. Additionally, in comparison to the control group, those in the disordered eating group exhibited blunted MAP reactivity to the initial stress exposure and less MAP habituation across both stress exposures. These findings indicate that disordered eating is characterized by dysregulated hemodynamic stress responsivity, which may constitute a physiological mechanism leading to poor physical health outcomes.
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Affiliation(s)
- Adam O' Riordan
- Department of Psychology and Neuroscience, Baylor University, Waco, TX, United States.
| | - Danielle A Young
- Department of Psychology and Neuroscience, Baylor University, Waco, TX, United States
| | - Annie T Ginty
- Department of Psychology and Neuroscience, Baylor University, Waco, TX, United States
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2
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Wiebe A, Kannen K, Selaskowski B, Mehren A, Thöne AK, Pramme L, Blumenthal N, Li M, Asché L, Jonas S, Bey K, Schulze M, Steffens M, Pensel MC, Guth M, Rohlfsen F, Ekhlas M, Lügering H, Fileccia H, Pakos J, Lux S, Philipsen A, Braun N. Virtual reality in the diagnostic and therapy for mental disorders: A systematic review. Clin Psychol Rev 2022; 98:102213. [PMID: 36356351 DOI: 10.1016/j.cpr.2022.102213] [Citation(s) in RCA: 16] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/19/2021] [Revised: 08/21/2022] [Accepted: 10/11/2022] [Indexed: 01/27/2023]
Abstract
BACKGROUND Virtual reality (VR) technologies are playing an increasingly important role in the diagnostics and treatment of mental disorders. OBJECTIVE To systematically review the current evidence regarding the use of VR in the diagnostics and treatment of mental disorders. DATA SOURCE Systematic literature searches via PubMed (last literature update: 9th of May 2022) were conducted for the following areas of psychopathology: Specific phobias, panic disorder and agoraphobia, social anxiety disorder, generalized anxiety disorder, posttraumatic stress disorder (PTSD), obsessive-compulsive disorder, eating disorders, dementia disorders, attention-deficit/hyperactivity disorder, depression, autism spectrum disorder, schizophrenia spectrum disorders, and addiction disorders. ELIGIBILITY CRITERIA To be eligible, studies had to be published in English, to be peer-reviewed, to report original research data, to be VR-related, and to deal with one of the above-mentioned areas of psychopathology. STUDY EVALUATION For each study included, various study characteristics (including interventions and conditions, comparators, major outcomes and study designs) were retrieved and a risk of bias score was calculated based on predefined study quality criteria. RESULTS Across all areas of psychopathology, k = 9315 studies were inspected, of which k = 721 studies met the eligibility criteria. From these studies, 43.97% were considered assessment-related, 55.48% therapy-related, and 0.55% were mixed. The highest research activity was found for VR exposure therapy in anxiety disorders, PTSD and addiction disorders, where the most convincing evidence was found, as well as for cognitive trainings in dementia and social skill trainings in autism spectrum disorder. CONCLUSION While VR exposure therapy will likely find its way successively into regular patient care, there are also many other promising approaches, but most are not yet mature enough for clinical application. REVIEW REGISTRATION PROSPERO register CRD42020188436. FUNDING The review was funded by budgets from the University of Bonn. No third party funding was involved.
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Affiliation(s)
- Annika Wiebe
- Department of Psychiatry and Psychotherapy, University Hospital Bonn, Bonn, Germany
| | - Kyra Kannen
- Department of Psychiatry and Psychotherapy, University Hospital Bonn, Bonn, Germany
| | - Benjamin Selaskowski
- Department of Psychiatry and Psychotherapy, University Hospital Bonn, Bonn, Germany
| | - Aylin Mehren
- Department of Psychiatry and Psychotherapy, University Hospital Bonn, Bonn, Germany
| | - Ann-Kathrin Thöne
- School of Child and Adolescent Cognitive Behavior Therapy (AKiP), Faculty of Medicine and University Hospital Cologne, University of Cologne, Cologne, Germany
| | - Lisa Pramme
- Department of Psychiatry and Psychotherapy, University Hospital Bonn, Bonn, Germany
| | - Nike Blumenthal
- Department of Psychiatry and Psychotherapy, University Hospital Bonn, Bonn, Germany
| | - Mengtong Li
- Department of Psychiatry and Psychotherapy, University Hospital Bonn, Bonn, Germany
| | - Laura Asché
- Department of Psychiatry and Psychotherapy, University Hospital Bonn, Bonn, Germany
| | - Stephan Jonas
- Institute for Digital Medicine, University Hospital Bonn, Bonn, Germany
| | - Katharina Bey
- Department of Psychiatry and Psychotherapy, University Hospital Bonn, Bonn, Germany
| | - Marcel Schulze
- Department of Psychiatry and Psychotherapy, University Hospital Bonn, Bonn, Germany
| | - Maria Steffens
- Department of Psychiatry and Psychotherapy, University Hospital Bonn, Bonn, Germany
| | - Max Christian Pensel
- Department of Psychiatry and Psychotherapy, University Hospital Bonn, Bonn, Germany
| | - Matthias Guth
- Department of Psychiatry and Psychotherapy, University Hospital Bonn, Bonn, Germany
| | - Felicia Rohlfsen
- Department of Psychiatry and Psychotherapy, University Hospital Bonn, Bonn, Germany
| | - Mogda Ekhlas
- Department of Psychiatry and Psychotherapy, University Hospital Bonn, Bonn, Germany
| | - Helena Lügering
- Department of Psychiatry and Psychotherapy, University Hospital Bonn, Bonn, Germany
| | - Helena Fileccia
- Department of Psychiatry and Psychotherapy, University Hospital Bonn, Bonn, Germany
| | - Julian Pakos
- Department of Psychiatry and Psychotherapy, University Hospital Bonn, Bonn, Germany
| | - Silke Lux
- Department of Psychiatry and Psychotherapy, University Hospital Bonn, Bonn, Germany
| | - Alexandra Philipsen
- Department of Psychiatry and Psychotherapy, University Hospital Bonn, Bonn, Germany
| | - Niclas Braun
- Department of Psychiatry and Psychotherapy, University Hospital Bonn, Bonn, Germany.
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3
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Pinhatti MM, Guerin KSDA, De Castro TG. Body Image Software Programs. UNIVERSITAS PSYCHOLOGICA 2022. [DOI: 10.11144/javeriana.upsy20.bisp] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/15/2022]
Abstract
The assessment of body image has evolved in recent decades through the development of various software programs. However, it is not yet known whether this technological advance has resulted in refined evidence or whether this assessment development has been extensively applied in the field. This study reviewed the body image software programs developed and applied from 2000 to 2020. Searches were systematically conducted in four scientific databases. A total of 35 articles were selected, and 13 body image software programs were identified. The main features comprising the variability of the software were the pattern of body stimuli presentation (avatars x real body x body drawings) and the procedures of body image manipulation (whole body adjustment x adjustment of separate body parts). Heterogeneity was prevalent among the studies reviewed and prevented a favorable conclusion regarding the use of software compared to other body image assessment strategies.
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4
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Magrini M, Curzio O, Tampucci M, Donzelli G, Cori L, Imiotti MC, Maestro S, Moroni D. Anorexia Nervosa, Body Image Perception and Virtual Reality Therapeutic Applications: State of the Art and Operational Proposal. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:ijerph19052533. [PMID: 35270226 PMCID: PMC8909096 DOI: 10.3390/ijerph19052533] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 12/24/2021] [Revised: 02/12/2022] [Accepted: 02/16/2022] [Indexed: 12/12/2022]
Abstract
Anorexia Nervosa (AN) patients exhibit distorted body representation. The purpose of this study was to explore studies that analyze virtual reality (VR) applications, related to body image issues, to propose a new tool in this field. We conducted a systematic review in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. PubMed, EMBASE, Scopus, and Web of Science databases were explored; the review included 25 studies. Research has increased over the last five years. The selected studies, clinical observational studies (n = 16), mostly concerning patients' population with AN (n = 14) or eating disorders (EDs) diagnosis, presented multiple designs, populations involved, and procedures. Some of these studies included healthy control groups (n = 7). Studies on community sample populations were also selected if oriented toward clinical applications (n = 9). The VR technologies in the examined period (about 20 years) have evolved significantly, going from very complex and bulky systems, requiring very powerful computers, to agile systems. The advent of low-cost VR devices has given a big boost to research works. Moreover, the operational proposal that emerges from this work supports the use of biofeedback techniques aimed at evaluating the results of therapeutic interventions in the treatment of adolescent patients diagnosed with AN.
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Affiliation(s)
- Massimo Magrini
- Institute of Information Science and Technologies “Alessandro Faedo”, National Research Council, Via Moruzzi 1, 56124 Pisa, Italy; (M.M.); (M.T.); (D.M.)
| | - Olivia Curzio
- Unit of Environmental Epidemiology, Institute of Clinical Physiology, National Research Council, Via Moruzzi 1, 56124 Pisa, Italy; (L.C.); (M.C.I.)
- Correspondence:
| | - Marco Tampucci
- Institute of Information Science and Technologies “Alessandro Faedo”, National Research Council, Via Moruzzi 1, 56124 Pisa, Italy; (M.M.); (M.T.); (D.M.)
| | - Gabriele Donzelli
- Department of Health Science, University of Florence, 50134 Florence, Italy;
| | - Liliana Cori
- Unit of Environmental Epidemiology, Institute of Clinical Physiology, National Research Council, Via Moruzzi 1, 56124 Pisa, Italy; (L.C.); (M.C.I.)
| | - Maria Cristina Imiotti
- Unit of Environmental Epidemiology, Institute of Clinical Physiology, National Research Council, Via Moruzzi 1, 56124 Pisa, Italy; (L.C.); (M.C.I.)
| | - Sandra Maestro
- Department of Developmental Neuroscience, IRCCS Stella Maris Foundation, 56128 Calambrone, Italy;
| | - Davide Moroni
- Institute of Information Science and Technologies “Alessandro Faedo”, National Research Council, Via Moruzzi 1, 56124 Pisa, Italy; (M.M.); (M.T.); (D.M.)
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5
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Xu C, Siegrist M, Hartmann C. The application of virtual reality in food consumer behavior research: A systematic review. Trends Food Sci Technol 2021. [DOI: 10.1016/j.tifs.2021.07.015] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
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6
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Bonev N, Matanova V. Adult Attachment Representations and Body Image. Front Psychol 2021; 12:724329. [PMID: 34566806 PMCID: PMC8461008 DOI: 10.3389/fpsyg.2021.724329] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/12/2021] [Accepted: 08/06/2021] [Indexed: 11/23/2022] Open
Abstract
In modern literature, the body image is interpreted as a multidimensional construct, which is considered important for both individual development and quality of life. The body image is central to the self-concept and has important consequences for mental functioning. A negative body image can result in adverse psychosocial consequences for both sexes. For a long time in the professional literature the study of socio-cultural factors on the development of the body image has prevailed. This line of research creates social constructivism, in which the earliest attachment relations are eliminated, and instead the idea is suggested that external sources have a direct influence. The present text proposes an approach to the body image as a development construct, arising and developing in the attachment relations, related to the provision of security and protection. Attachment disturbances, as well as attachment disorganization, are defined as the inability to provide security and protection. Attachment relationships in connection with the development of body image develop through the mechanisms of reflection, sensitive responses to the child’s signals and synchronous relationships. In the first months of human life, the attachment needs are first and foremost the needs of the body, which are satisfied by the responses of the primary caregiver. The topic of body image discusses attachment disorganization, the understanding of attachment trauma, and the “enactment” of the loss on the body’s territory. Trauma always involves loss. Griefs that cannot be mourned and injuries that cannot be represented seem to be central to understanding the body’s problematization.
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Affiliation(s)
- Nikolay Bonev
- Master Program in Clinical Psychology, Department of Social, Work, Clinical and Educational Psychology, Faculty of Philosophy, Sofia University "St. Kliment Ohridski", Sofia, Bulgaria
| | - Vanya Matanova
- Master Program in Clinical Psychology, Department of Social, Work, Clinical and Educational Psychology, Faculty of Philosophy, Sofia University "St. Kliment Ohridski", Sofia, Bulgaria
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7
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Schaumberg K, Reilly EE, Gorrell S, Levinson CA, Farrell NR, Brown TA, Smith KM, Schaefer LM, Essayli JH, Haynos AF, Anderson LM. Conceptualizing eating disorder psychopathology using an anxiety disorders framework: Evidence and implications for exposure-based clinical research. Clin Psychol Rev 2020; 83:101952. [PMID: 33221621 DOI: 10.1016/j.cpr.2020.101952] [Citation(s) in RCA: 49] [Impact Index Per Article: 12.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/01/2019] [Revised: 11/09/2020] [Accepted: 11/09/2020] [Indexed: 12/13/2022]
Abstract
Eating disorders (EDs) and anxiety disorders (ADs) evidence shared risk and significant comorbidity. Recent advances in understanding of anxiety-based disorders may have direct application to research and treatment efforts for EDs. The current review presents an up-to-date, behavioral conceptualization of the overlap between anxiety-based disorders and EDs. We identify ways in which anxiety presents in EDs, consider differences between EDs and ADs relevant to treatment adaptions, discuss how exposure-based strategies may be adapted for use in ED treatment, and outline directions for future mechanistic, translational, and clinical ED research from this perspective. Important research directions include: simultaneous examination of the extent to which EDs are characterized by aberrant avoidance-, reward-, and/or habit-based neurobiological and behavioral processes; improvement in understanding of how nutritional status interacts with neurobiological characteristics of EDs; incorporation of a growing knowledge of biobehavioral signatures in ED treatment planning; development of more comprehensive exposure-based treatment approaches for EDs; testing whether certain exposure interventions for AD are appropriate for EDs; and improvement in clinician self-efficacy and ability to use exposure therapy for EDs.
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Affiliation(s)
| | | | - Sasha Gorrell
- University of California, San Francisco, United States of America
| | - Cheri A Levinson
- University of Louisville, Department of Psychological & Brain Sciences, United States of America
| | | | - Tiffany A Brown
- University of California, San Diego, United States of America
| | - Kathryn M Smith
- Sanford Health, United States of America; University of Southern California, United States of America
| | | | | | - Ann F Haynos
- University of Minnesota, United States of America
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8
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Stramba-Badiale C, Mancuso V, Cavedoni S, Pedroli E, Cipresso P, Riva G. Transcranial Magnetic Stimulation Meets Virtual Reality: The Potential of Integrating Brain Stimulation With a Simulative Technology for Food Addiction. Front Neurosci 2020; 14:720. [PMID: 32760243 PMCID: PMC7372037 DOI: 10.3389/fnins.2020.00720] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/14/2020] [Accepted: 06/16/2020] [Indexed: 12/23/2022] Open
Abstract
The aim of this perspective is to propose and discuss the integration of transcranial magnetic stimulation (TMS) over the dorsolateral prefrontal cortex with virtual reality (VR) food exposure for therapeutic interventions for food addiction. "Food addiction" is a dysfunctional eating pattern which is typically observed in eating disorders (ED) such as bulimia nervosa and binge eating disorder. Food addiction has been compared to substance use disorder due to the necessity of consuming a substance (food) and the presence of a dependence behavior. In recent years, VR has been applied in the treatment of ED because it triggers psychological and physiological responses through food exposure in place of real stimuli. Virtual reality-Cue exposure therapy has been proven as a valid technique for regulating anxiety and food craving in ED. More, TMS has been proven to modulate circuits and networks implicated in neuropsychiatric disorders and is effective in treating addiction such as nicotine craving and consumption and cocaine use disorder. The combination of a simulative technology and a neurostimulation would presumably provide better improvement compared to a single intervention because it implies the presence of both cognitive and neuropsychological techniques. The possible advantage of this approach will be discussed in the perspective.
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Affiliation(s)
- Chiara Stramba-Badiale
- Applied Technology for Neuro-Psychology Lab, Istituto Auxologico Italiano, Istituto di Ricovero e Cura a Carattere Scientifico, Milan, Italy
| | - Valentina Mancuso
- Applied Technology for Neuro-Psychology Lab, Istituto Auxologico Italiano, Istituto di Ricovero e Cura a Carattere Scientifico, Milan, Italy
| | - Silvia Cavedoni
- Applied Technology for Neuro-Psychology Lab, Istituto Auxologico Italiano, Istituto di Ricovero e Cura a Carattere Scientifico, Milan, Italy
| | - Elisa Pedroli
- Applied Technology for Neuro-Psychology Lab, Istituto Auxologico Italiano, Istituto di Ricovero e Cura a Carattere Scientifico, Milan, Italy
- Department of Psychology, E-Campus University, Novedrate, Italy
| | - Pietro Cipresso
- Applied Technology for Neuro-Psychology Lab, Istituto Auxologico Italiano, Istituto di Ricovero e Cura a Carattere Scientifico, Milan, Italy
- Department of Psychology, Catholic University of the Sacred Heart, Milan, Italy
| | - Giuseppe Riva
- Applied Technology for Neuro-Psychology Lab, Istituto Auxologico Italiano, Istituto di Ricovero e Cura a Carattere Scientifico, Milan, Italy
- Department of Psychology, Catholic University of the Sacred Heart, Milan, Italy
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9
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Comparison of body image evaluation by virtual reality and paper-based figure rating scales in adolescents with anorexia nervosa: retrospective study. Eat Weight Disord 2020; 25:735-743. [PMID: 30977098 DOI: 10.1007/s40519-019-00680-1] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/18/2018] [Accepted: 03/15/2019] [Indexed: 12/15/2022] Open
Abstract
PURPOSE Assessment of the symptoms of body image disorder (BID) is crucial in anorexia nervosa (AN). Recent technological advancements such as virtual reality (VR) have improved the visual perception with 3D avatars and the feeling to be the avatar with the immersive conditions. This retrospective study examines the hypothesis that VR with standardized 3D avatars would improve body image perception and then body image evaluation by adolescents with AN, compared to the paper-based figure rating scales (FRS). METHODS Data of 31 female adolescents with AN were retrospectively studied. Paired data of perceived and desired body forms in addition to body perception index (BPI) (p = 0.2) and body dissatisfaction (p = 0.6), obtained by both VR and FRS were compared. Furthermore, correlation with validated psychometric questionnaires was also studied. Head-tracking technology allowed for the implicit measurement of explicit choices of patients. RESULTS Participants with AN overestimated own body size regardless of the assessment tool used. BPI and body dissatisfaction did not differ significantly between FRS and VR. VR-based evaluation was correlated with the psychometric parameters BID and body dissatisfaction. Head tracking revealed significantly longer participant engagement with avatars representing malnutrition and underweight states, while those least engaged corresponded to obesity. CONCLUSIONS Results of BID evaluation by VR standardized 3D avatars are comparable to those obtained by paper-based FRS. These findings suggest that comparable results obtained by both tools of evaluation reflect primarily the role of affective-cognitive perturbation in BID. The perceptive component could be better evaluated using biometric-enhanced assessment tools. LEVEL OF EVIDENCE Level V, cross-sectional descriptive study (evaluation data retrospectively studied).
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10
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Exposure therapy for eating disorders: A systematic review. Clin Psychol Rev 2020; 78:101851. [DOI: 10.1016/j.cpr.2020.101851] [Citation(s) in RCA: 42] [Impact Index Per Article: 10.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/17/2019] [Revised: 03/07/2020] [Accepted: 03/10/2020] [Indexed: 12/25/2022]
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11
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Birckhead B, Khalil C, Liu X, Conovitz S, Rizzo A, Danovitch I, Bullock K, Spiegel B. Recommendations for Methodology of Virtual Reality Clinical Trials in Health Care by an International Working Group: Iterative Study. JMIR Ment Health 2019; 6:e11973. [PMID: 30702436 PMCID: PMC6374734 DOI: 10.2196/11973] [Citation(s) in RCA: 137] [Impact Index Per Article: 27.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/19/2018] [Revised: 10/23/2018] [Accepted: 10/23/2018] [Indexed: 01/04/2023] Open
Abstract
BACKGROUND Therapeutic virtual reality (VR) has emerged as an efficacious treatment modality for a wide range of health conditions. However, despite encouraging outcomes from early stage research, a consensus for the best way to develop and evaluate VR treatments within a scientific framework is needed. OBJECTIVE We aimed to develop a methodological framework with input from an international working group in order to guide the design, implementation, analysis, interpretation, and communication of trials that develop and test VR treatments. METHODS A group of 21 international experts was recruited based on their contributions to the VR literature. The resulting Virtual Reality Clinical Outcomes Research Experts held iterative meetings to seek consensus on best practices for the development and testing of VR treatments. RESULTS The interactions were transcribed, and key themes were identified to develop a scientific framework in order to support best practices in methodology of clinical VR trials. Using the Food and Drug Administration Phase I-III pharmacotherapy model as guidance, a framework emerged to support three phases of VR clinical study designs-VR1, VR2, and VR3. VR1 studies focus on content development by working with patients and providers through the principles of human-centered design. VR2 trials conduct early testing with a focus on feasibility, acceptability, tolerability, and initial clinical efficacy. VR3 trials are randomized, controlled studies that evaluate efficacy against a control condition. Best practice recommendations for each trial were provided. CONCLUSIONS Patients, providers, payers, and regulators should consider this best practice framework when assessing the validity of VR treatments.
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Affiliation(s)
- Brandon Birckhead
- Division of Health Services Research, Department of Medicine, Cedars-Sinai Health System, Los Angeles, CA, United States
| | - Carine Khalil
- Division of Health Services Research, Department of Medicine, Cedars-Sinai Health System, Los Angeles, CA, United States.,Laboratoire Interdisciplinaire de Recherche Appliquée en Économie de la Santé, Paris Descartes University, Paris, France
| | - Xiaoyu Liu
- Division of Health Services Research, Department of Medicine, Cedars-Sinai Health System, Los Angeles, CA, United States.,Department of Health Policy and Management, Fielding School of Public Health, University of California, Los Angeles, Los Angeles, CA, United States
| | - Samuel Conovitz
- Division of Health Services Research, Department of Medicine, Cedars-Sinai Health System, Los Angeles, CA, United States.,Department of Health Policy and Management, Fielding School of Public Health, University of California, Los Angeles, Los Angeles, CA, United States
| | - Albert Rizzo
- Institute for Creative Technologies, University of Southern California, Los Angeles, CA, United States
| | - Itai Danovitch
- Department of Psychiatry, Cedars-Sinai Health System, Los Angeles, CA, United States
| | - Kim Bullock
- Department of Psychiatry, Stanford University School of Medicine, Palo Alto, CA, United States
| | - Brennan Spiegel
- Division of Health Services Research, Department of Medicine, Cedars-Sinai Health System, Los Angeles, CA, United States.,Department of Health Policy and Management, Fielding School of Public Health, University of California, Los Angeles, Los Angeles, CA, United States
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12
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Riva G, Gutiérrez-Maldonado J, Dakanalis A, Ferrer-García M. Virtual Reality in the Assessment and Treatment of Weight-Related Disorders. VIRTUAL REALITY FOR PSYCHOLOGICAL AND NEUROCOGNITIVE INTERVENTIONS 2019. [DOI: 10.1007/978-1-4939-9482-3_7] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/05/2022]
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13
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Brockmeyer T, Friederich HC, Schmidt U. Advances in the treatment of anorexia nervosa: a review of established and emerging interventions. Psychol Med 2018; 48:1228-1256. [PMID: 28889819 DOI: 10.1017/s0033291717002604] [Citation(s) in RCA: 96] [Impact Index Per Article: 16.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
BACKGROUND Anorexia nervosa (AN) is a disabling, deadly and costly mental disorder. Until recently, treatment recommendations were based on expert opinion and limited evidence. The aim of this systematic review is to synthesise recent evidence on established and emerging AN treatments and to forecast trends for future developments. METHODS We systematically review trials of established treatments and associated process outcome studies from the last 5 years, published since a previous review in this journal. 'Established' treatments were those that are widely used in AN, recommended by guidelines and/or have been tested in at least one large randomised controlled trial. Secondly, we summarise emerging treatments for AN, i.e. those that have only been (or are currently being) tested in proof-of concept, feasibility or pilot trials. RESULTS We identified 19 published trials of established treatments (15 of high or moderate quality), mostly assessing psychological therapies (n = 17). We also found 11 published trials of emerging treatments, and a total of 34 registered, as yet unpublished trials. Promising emerging treatments include cognitive remediation therapy, exposure therapy and non-invasive neuromodulation. CONCLUSIONS Evidence generation on the treatment of AN has dramatically accelerated, with our understanding of the role of family-based approaches for adolescents more nuanced and a range of psychological approaches available for the treatment of adults. Evidence on emerging treatments and from forthcoming trials suggests that there is a shift towards more targeted brain-based interventions. Future studies need to focus on elucidating mechanisms of action of treatments and what works best for whom.
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Affiliation(s)
- T Brockmeyer
- Department of Psychosomatic Medicine and Psychotherapy,LVR Clinic,Medical Faculty of the Heinrich-Heine-University Düsseldorf,Düsseldorf,Germany
| | - H-C Friederich
- Department of Psychosomatic Medicine and Psychotherapy,LVR Clinic,Medical Faculty of the Heinrich-Heine-University Düsseldorf,Düsseldorf,Germany
| | - U Schmidt
- Section of Eating Disorders,Department of Psychological Medicine,Institute of Psychiatry,Psychology and Neuroscience,King's College London,London,UK
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14
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Clus D, Larsen ME, Lemey C, Berrouiguet S. The Use of Virtual Reality in Patients with Eating Disorders: Systematic Review. J Med Internet Res 2018; 20:e157. [PMID: 29703715 PMCID: PMC5948410 DOI: 10.2196/jmir.7898] [Citation(s) in RCA: 70] [Impact Index Per Article: 11.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/28/2017] [Revised: 09/28/2017] [Accepted: 11/16/2017] [Indexed: 12/17/2022] Open
Abstract
Background Patients with eating disorders are characterized by pathological eating habits and a tendency to overestimate their weight and body shape. Virtual reality shows promise for the evaluation and management of patients with eating disorders. This technology, when accepted by this population, allows immersion in virtual environments, assessment, and therapeutic approaches, by exposing users to high-calorie foods or changes in body shape. Objective To better understand the value of virtual reality, we conducted a review of the literature, including clinical studies proposing the use of virtual reality for the evaluation and management of patients with eating disorders. Methods We searched PubMed, PsycINFO, ScienceDirect, the Cochrane Library, Scopus, and Web of Science up to April 2017. We created the list of keywords based on two domains: virtual reality and eating disorders. We used the Preferred Reporting Items for Systematic Reviews and Meta-Analyses to identify, select, and critically appraise relevant research while minimizing bias. Results The initial database searches identified 311 articles, 149 of which we removed as duplicates. We analyzed the resulting set of 26 unique studies that met the inclusion criteria. Of these, 8 studies were randomized controlled trials, 13 were nonrandomized studies, and 5 were clinical trials with only 1 participant. Most articles focused on clinical populations (19/26, 73%), with the remainder reporting case-control studies (7/26, 27%). Most of the studies used visual immersive equipment (16/26, 62%) with a head-mounted display (15/16, 94%). Two main areas of interest emerged from these studies: virtual work on patients’ body image (7/26, 27%) and exposure to virtual food stimuli (10/26, 38%). Conclusions We conducted a broad analysis of studies on the use of virtual reality in patients with eating disorders. This review of the literature showed that virtual reality is an acceptable and promising therapeutic tool for patients with eating disorders.
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Affiliation(s)
- Damien Clus
- Department of Mental Health, University Hospital of Brest, Brest, France
| | - Mark Erik Larsen
- Black Dog Institute, University of New South Wales, Sydney, Australia
| | - Christophe Lemey
- Department of Mental Health, University Hospital of Brest, Université de Bretagne Occidentale, Brest, France
| | - Sofian Berrouiguet
- UMR CNRS 6285 Lab-STICC, Institut Mines Télécom Atlantique, Université Bretagne Loire F-29238 Brest, Brest, France.,EA 7479 Soins Primaires, Santé Publique et Registre des cancers de Bretagne Occidentale, Department of Mental Health, Université de Bretagne Occidentale, Brest, France
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Chubby hands or little fingers: sex differences in hand representation. PSYCHOLOGICAL RESEARCH 2018; 83:1375-1382. [PMID: 29616336 DOI: 10.1007/s00426-018-1003-x] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/06/2017] [Accepted: 03/30/2018] [Indexed: 12/24/2022]
Abstract
Disturbed body representation is a condition defined by the perception that one's body size is different from their anatomical size. While equal amounts of males and females suffer from disturbed body representation, there appear to be differences in the direction of this distortion. Females will typically overestimate, whereas males will typically underestimate body size. One part of the body that has been consistently misperceived is the hands. This misrepresentation consists of two distinct characteristics: an overestimation of hand width, and an underestimation of finger length. Many of these studies, however, have used predominately female participants, allowing for the possibility that women are driving this distortion. The aim of the present study was to examine possible sex differences in hand perception. To this end, participants estimated the location of ten landmarks on their hands when their hands were hidden from view. Our results indicate that females follow the characteristic distortion, whereas males only underestimate finger length (albeit more than females). These findings are surprising, because the hands are not an area of concern for weight gain/loss. We discuss these findings in relation to body dysmorphia literature.
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Reactivity to interpersonal stress in patients with eating disorders: A systematic review and meta-analysis of studies using an experimental paradigm. Neurosci Biobehav Rev 2018; 87:133-150. [DOI: 10.1016/j.neubiorev.2018.02.002] [Citation(s) in RCA: 39] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/02/2017] [Revised: 02/05/2018] [Accepted: 02/05/2018] [Indexed: 12/20/2022]
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Larson N, Haynos AF, Roberto CA, Loth KA, Neumark-Sztainer D. Calorie Labels on the Restaurant Menu: Is the Use of Weight-Control Behaviors Related to Ordering Decisions? J Acad Nutr Diet 2018; 118:399-408. [PMID: 29325890 DOI: 10.1016/j.jand.2017.11.007] [Citation(s) in RCA: 24] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/23/2017] [Accepted: 11/09/2017] [Indexed: 11/19/2022]
Abstract
BACKGROUND There is emerging evidence that calorie information on restaurant menus does not similarly influence the ordering decisions of all population groups and may have unintended consequences for individuals who struggle with disordered eating or other weight-related concerns. OBJECTIVE This study describes demographic patterns in the use of calorie information on restaurant menus and investigates relationships between using this information to limit calorie intake and measures of restaurant visit frequency and weight-related concerns and behavior. DESIGN/PARTICIPANTS There were 788 men and 1042 women (mean age=31.0±1.6 years) who participated in the fourth wave of the Project EAT study. Participants were initially recruited from Minneapolis-St Paul, MN, schools and completed EAT-IV surveys online or by mail from 2015 to 2016. MAIN OUTCOME MEASURES Participants self-reported weight-related concerns, restaurant eating, intuitive eating, dieting, healthy (eg, exercise) and unhealthy (eg, use of laxatives) weight-control behaviors, and binge eating. STATISTICAL ANALYSES PERFORMED Descriptive statistics and linear and logistic regression models accounting for demographics and weight status. RESULTS Approximately half of participants (52.7%) reported they had noticed calorie information while purchasing a meal or snack in a restaurant within the previous month. Among individuals who noticed calorie information, 38.2% reported they did not use it in deciding what to order. The most common use of calorie information was to avoid high-calorie menu items (50.1%) or to decide on a smaller portion (20.2%). Using menu labels to limit calories was related to binge eating among women and was associated with more weight-related concerns, dieting, and unhealthy weight-control behaviors among both women and men. CONCLUSIONS Nutrition educators and other health care professionals should talk with clients who struggle with disordered eating or weight-related concerns to learn about their use of calorie information at restaurants, address any potential unintended consequences, and promote healthy uses of calorie information.
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Eating behavior style predicts craving and anxiety experienced in food-related virtual environments by patients with eating disorders and healthy controls. Appetite 2017; 117:284-293. [DOI: 10.1016/j.appet.2017.07.007] [Citation(s) in RCA: 25] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/15/2017] [Revised: 06/22/2017] [Accepted: 07/10/2017] [Indexed: 12/26/2022]
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Virtual Reality as a Promising Strategy in the Assessment and Treatment of Bulimia Nervosa and Binge Eating Disorder: A Systematic Review. Behav Sci (Basel) 2017; 7:bs7030043. [PMID: 28698483 PMCID: PMC5618051 DOI: 10.3390/bs7030043] [Citation(s) in RCA: 35] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/05/2017] [Revised: 07/05/2017] [Accepted: 07/06/2017] [Indexed: 11/16/2022] Open
Abstract
Several lines of evidence suggest that Virtual Reality (VR) has a potential utility in eating disorders. The objective of this study is to review the literature on the use of VR in bulimia nervosa (BN) and binge eating disorder (BED). Using PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) statement for reporting systematic reviews, we performed a PubMed, Web of Knowledge and SCOPUS search to identify studies employing VR in the assessment and treatment of BN and BED. The following search terms were used: "virtual reality", "eating disorders", "binge eating", and "bulimia nervosa". From the 420 articles identified, 19 were selected, nine investigated VR in assessment and 10 were treatment studies (one case-report, two non-controlled and six randomized controlled trials). The studies using VR in BN and BED are at an early stage. However, considering the available evidence, the use of VR in the assessment of those conditions showed some promise in identifying: (1) how those patients experienced their body image; and (2) environments or specific kinds of foods that may trigger binge-purging cycle. Some studies using VR-based environments associated to cognitive behavioral techniques showed their potential utility in improving motivation for change, self-esteem, body image disturbances and in reducing binge eating and purging behavior.
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20
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Haynos AF, Roberto CA. The effects of restaurant menu calorie labeling on hypothetical meal choices of females with disordered eating. Int J Eat Disord 2017; 50:275-283. [PMID: 28130796 PMCID: PMC5378635 DOI: 10.1002/eat.22675] [Citation(s) in RCA: 25] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/07/2016] [Revised: 12/15/2016] [Accepted: 12/29/2016] [Indexed: 11/09/2022]
Abstract
Concerns have been raised that obesity public policy measures may have harmful effects on individuals with eating disorders. However, little research has investigated this topic. We examined the impact of a popular obesity public policy, menu calorie labeling, on hypothetical food choices of women with disordered eating. Seven hundred sixteen adult females completed an online survey in which they were randomly assigned to receive a restaurant menu with or without calorie information listed. Participants selected foods representative of a meal they would choose to consume and answered questions on restaurant ordering and menu labeling. Participants completed the Eating Disorder Examination Questionnaire (Fairburn & Beglin, ) to assess global eating pathology. Diagnoses of anorexia nervosa (AN), bulimia nervosa (BN), and binge-eating disorder (BED) were also derived from this measure. Generalized linear modeling examined the impact of menu label condition, disordered eating, and the menu label by disordered eating interaction on hypothetical food selection and related variables. When disordered eating was examined continuously, menu labeling did not differentially affect food selections of those with elevated disordered eating (p = .45). However, when examined by eating disorder diagnosis, participants with AN or BN ordered significantly fewer (p < .001) and participants with BED ordered significantly more (p = .001) calories in the menu label versus no label condition. Menu labeling may decrease the calories ordered among individuals with AN or BN and increase calories ordered among individuals with BED.
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Affiliation(s)
- Ann F. Haynos
- University of Minnesota Medical Center, Minneapolis, MN
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21
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Wiederhold BK, Riva G, Gutiérrez-Maldonado J. Virtual Reality in the Assessment and Treatment of Weight-Related Disorders. CYBERPSYCHOLOGY BEHAVIOR AND SOCIAL NETWORKING 2016; 19:67-73. [PMID: 26882323 DOI: 10.1089/cyber.2016.0012] [Citation(s) in RCA: 35] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Abstract
Virtual Reality (VR) has, for the past two decades, proven to be a useful adjunctive tool for both assessment and treatment of patients with eating disorders and obesity. VR allows an individual to enter scenarios that simulate real-life situations and to encounter food cues known to trigger his/her disordered eating behavior. As well, VR enables three-dimensional figures of the patient's body to be presented, helping him/her to reach an awareness of body image distortion and then providing the opportunity to confront and correct distortions, resulting in a more realistic body image and a decrease in body image dissatisfaction. In this paper, we describe seminal studies in this research area.
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Affiliation(s)
- Brenda K Wiederhold
- 1 Virtual Reality Medical Center , San Diego, California.,2 Virtual Reality Medical Institute , Brussels, Belgium
| | - Giuseppe Riva
- 3 Department of Psychology, Università Cattolica del Sacro Cuore , Milan, Italy .,4 Applied Technology for Neuro-Psychology Laboratory, Istituto Auxologico Italiano , Milan, Italy
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Perpiñá C, Roncero M. Similarities and differences between eating disorders and obese patients in a virtual environment for normalizing eating patterns. Compr Psychiatry 2016; 67:39-45. [PMID: 27095333 DOI: 10.1016/j.comppsych.2016.02.012] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/01/2015] [Revised: 02/04/2016] [Accepted: 02/06/2016] [Indexed: 10/22/2022] Open
Abstract
Virtual reality has demonstrated promising results in the treatment of eating disorders (ED); however, few studies have examined its usefulness in treating obesity. The aim of this study was to compare ED and obese patients on their reality judgment of a virtual environment (VE) designed to normalize their eating pattern. A second objective was to study which variables predicted the reality of the experience of eating a virtual forbidden-fattening food. ED patients, obese patients, and a non-clinical group (N=62) experienced a non-immersive VE, and then completed reality judgment and presence measures. All participants rated the VE with similar scores for quality, interaction, engagement, and ecological validity; however, ED patients obtained the highest scores on emotional involvement, attention, reality judgment/presence, and negative effects. The obese group gave the lowest scores to reality judgment/presence, satisfaction and sense of physical space, and they held an intermediate position in the attribution of reality to virtually eating a "fattening" food. The palatability of a virtual food was predicted by attention capturing and belonging to the obese group, while the attribution of reality to the virtual eating was predicted by engagement and belonging to the ED group. This study offers preliminary results about the differential impact on ED and obese patients of the exposure to virtual food, and about the need to implement a VE that can be useful as a virtual lab for studying eating behavior and treating obesity.
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Affiliation(s)
- Conxa Perpiñá
- University of Valencia, Spain; CIBER Fisiopatología Obesidad y Nutrición (CIBERobn), Instituto Salud Carlos III, Spain.
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Mountford VA, Tchanturia K, Valmaggia L. “What Are You Thinking When You Look at Me?” A Pilot Study of the Use of Virtual Reality in Body Image. CYBERPSYCHOLOGY BEHAVIOR AND SOCIAL NETWORKING 2016; 19:93-9. [DOI: 10.1089/cyber.2015.0169] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/04/2023]
Affiliation(s)
- Victoria A. Mountford
- Psychological Medicine, Institute of Psychiatry, Psychology, & Neuroscience, King's College London, London, United Kingdom
- Eating Disorders Service, South London and Maudsley NHS Foundation Trust, Maudsley Hospital, Denmark Hill, London, United Kingdom
| | - Kate Tchanturia
- Psychological Medicine, Institute of Psychiatry, Psychology, & Neuroscience, King's College London, London, United Kingdom
- Eating Disorders Service, South London and Maudsley NHS Foundation Trust, Maudsley Hospital, Denmark Hill, London, United Kingdom
| | - Lucia Valmaggia
- Psychological Medicine, Institute of Psychiatry, Psychology, & Neuroscience, King's College London, London, United Kingdom
- Virtual Reality Lab, NIHR/Wellcome Trust, King's Clinical Research Facilities, King's Hospital London, London, United Kingdom
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Lupis SB, Sabik NJ, Wolf JM. Role of shame and body esteem in cortisol stress responses. J Behav Med 2015; 39:262-75. [PMID: 26577952 DOI: 10.1007/s10865-015-9695-5] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/07/2015] [Accepted: 11/02/2015] [Indexed: 10/22/2022]
Abstract
Studies assessing the role of shame in HPA axis reactivity report mixed findings. Discrepancies may be due to methodological difficulties and inter-individual differences in the propensity to experience shame in a stressful situation. Hence, the current study combined self-report of shame and facial coding of shame expressions and assessed the role of body esteem as a moderator of the shame-stress link. For this, 44 healthy students (24F, age 20.5 ± 2.1 years) were exposed to an acute psychosocial stress paradigm (Trier Social Stress Test: TSST). Salivary cortisol levels were measured throughout the protocol. Trait shame was measured before the stress test, and state shame immediately afterwards. Video recordings of the TSST were coded to determine emotion expressions. State shame was neither associated with cortisol stress responses nor with body esteem (self-report: all ps ≥ .24; expression: all ps ≥ .31). In contrast, higher trait shame was associated with both negative body esteem (p = .049) and stronger cortisol stress responses (p = .013). Lastly, having lower body esteem predicted stronger cortisol stress responses (p = .022); however, it did not significantly moderate the association between shame indices and cortisol stress responses (all ps ≥ .94). These findings suggest that body esteem and trait shame independently contribute to strength of cortisol stress responses. Thus, in addition to trait shame, body esteem emerged as an important predictor of cortisol stress responses and as such, a potential contributor to stress-related negative health outcomes.
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Affiliation(s)
- Sarah B Lupis
- Department of Psychology, Brandeis University, 415 South St, MS 062, Waltham, MA, 02454, USA
| | - Natalie J Sabik
- Department of Psychology, Brandeis University, 415 South St, MS 062, Waltham, MA, 02454, USA.,Health Studies, University of Rhode Island, 25 Independence Way, Kingston, RI, 02881, USA
| | - Jutta M Wolf
- Department of Psychology, Brandeis University, 415 South St, MS 062, Waltham, MA, 02454, USA.
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25
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Roncero M, Perpiñá C. Normalizing the eating pattern with virtual reality for bulimia nervosa: a case report. ACTA ACUST UNITED AC 2015. [DOI: 10.1016/j.rmta.2015.11.001] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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The effects of calorie labels on those at high-risk of eating pathologies: a pre-post intervention study in a University cafeteria. Public Health 2015; 129:732-9. [PMID: 25931435 DOI: 10.1016/j.puhe.2015.03.005] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/10/2014] [Revised: 02/23/2015] [Accepted: 03/07/2015] [Indexed: 10/23/2022]
Abstract
OBJECTIVES The aim of the study was to examine the effect of a public policy (menu labelling) on those at high-risk for eating pathologies. Specifically, the study looked for any adverse effects related to eating disturbance level. STUDY DESIGN The study employed a pre-post intervention design. Baseline collection took place in October 2012. One week prior to follow-up in November 2012, calorie labels were displayed next to virtually all menu items in a University cafeteria. Labels remained throughout the entire duration of follow-up. METHODS Participants were female undergraduates (N = 299). At baseline and follow-up, a survey assessed eating disturbance level (Eating Attitudes Test-26), emotional state, frequency of engaging in unhealthy weight-related behaviours, and calorie consumption. RESULTS Generalized estimating equations were used to test changes in negative outcomes over time in response to calorie labels. Calorie consumption did not significantly decrease from baseline (mean = 660.5 kcal) to follow-up (mean = 600.5 kcal; P = 0.104). There were no changes in emotional states such as body image satisfaction (P = 0.447), anxiety (P = 0.595), positive affect (P = 0.966), negative affect (P = 0.576), and unhealthy weight-related behaviours such as binging (P = 0.268), exercising excessively (P = 0.847), or restricting calories (P = 0.504). Additionally, there were no interactions between eating disturbance level and time. CONCLUSIONS Overall, no adverse outcomes were found for this at-risk population. Calorie labels did not differentially affect those with higher levels of eating disturbance. Future research should focus on examining the impact of calorie labels among those with clinical eating disorders.
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Gardner RM, Brown DL. Body size estimation in anorexia nervosa: a brief review of findings from 2003 through 2013. Psychiatry Res 2014; 219:407-10. [PMID: 25023364 DOI: 10.1016/j.psychres.2014.06.029] [Citation(s) in RCA: 83] [Impact Index Per Article: 8.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/23/2013] [Revised: 06/08/2014] [Accepted: 06/18/2014] [Indexed: 11/28/2022]
Abstract
Body size overestimation is a fundamental feature in anorexia nervosa (AN). The extent or even existence of body size overestimation in AN is controversial. The most recent review (Farrell et al., 2005) found that only half the studies reported overestimation of body size in individuals diagnosed with AN. The remaining studies found no overestimation or in some instances underestimation. The discrepancy in these findings has been attributed to the wide variety of assessment techniques that are used, including many with questionable psychometric properties. We review all 9 contemporary studies conducted in this area since the last review in 2005. For each study we describe the number of participants, methodology, reliability/validity data, amount of whole body distortion, effect sizes, and a summary of findings. In all studies that included a healthy control group, individuals with AN overestimated their whole body size more than healthy controls did. The difference was significant in all except two studies. Based on these contemporary findings, we conclude that individuals with AN overestimate their body size and that the greater consistency of findings in the studies conducted over the last decade is attributable to the use of improved methodologies and assessment tools with documented psychometric properties.
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Affiliation(s)
- Rick M Gardner
- Department of Psychology, University of Colorado Denver, Denver, Colorado, USA.
| | - Dana L Brown
- Department of Psychology, University of Colorado Denver, Denver, Colorado, USA
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Ledoux T, Nguyen AS, Bakos-Block C, Bordnick P. Using virtual reality to study food cravings. Appetite 2013; 71:396-402. [PMID: 24055758 DOI: 10.1016/j.appet.2013.09.006] [Citation(s) in RCA: 47] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/12/2012] [Revised: 07/26/2013] [Accepted: 09/08/2013] [Indexed: 11/15/2022]
Abstract
Food cravings (FCs) are associated with overeating and obesity and are triggered by environmental cues. The study of FCs is challenged by difficulty replicating the natural environment in a laboratory. Virtual reality (VR) could be used to deliver naturalistic cues in a laboratory. The purpose of this study was to investigate whether food related cues delivered by VR could induce greater FCs than neutral VR cues, photographic food cues, or real food. Sixty normal weight non-dieting women were recruited; and, to prevent a floor effect, half were primed with a monotonous diet (MD). Experimental procedures involved delivering neutral cues via VR and food related cues via VR, photographs, and real food in counterbalanced order while measuring subjective (self-report) and objective (salivation) FCs. FCs produced by VR were marginally greater than a neutral cue, not significantly different from picture cues, and significantly less than real food. The modest effects may have been due to quality of the VR system and/or measures of FC (i.e., self-report and salivation). FC threshold among non-dieting normal weight women was lowered with the use of a MD condition. Weight loss programs with monotonous diets may inadvertently increase FCs making diet compliance more difficult.
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Affiliation(s)
- Tracey Ledoux
- Department of Health and Human Performance, University of Houston, 3855 Holman Street, Garrison Gym Rm 104, Houston, TX 77204-6015, USA.
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Virtual Reality Based Treatments in Eating Disorders and Obesity: A Review. JOURNAL OF CONTEMPORARY PSYCHOTHERAPY 2013. [DOI: 10.1007/s10879-013-9240-1] [Citation(s) in RCA: 62] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
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The use of virtual reality in the study, assessment, and treatment of body image in eating disorders and nonclinical samples: a review of the literature. Body Image 2012; 9:1-11. [PMID: 22119329 DOI: 10.1016/j.bodyim.2011.10.001] [Citation(s) in RCA: 82] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/21/2011] [Revised: 10/13/2011] [Accepted: 10/13/2011] [Indexed: 11/20/2022]
Abstract
This article reviews research into the use of virtual reality in the study, assessment, and treatment of body image disturbances in eating disorders and nonclinical samples. During the last decade, virtual reality has emerged as a technology that is especially suitable not only for the assessment of body image disturbances but also for its treatment. Indeed, several virtual environment-based software systems have been developed for this purpose. Furthermore, virtual reality seems to be a good alternative to guided imagery and in vivo exposure, and is therefore very useful for studies that require exposure to life-like situations but which are difficult to conduct in the real world. Nevertheless, review highlights the lack of published controlled studies and the presence of methodological drawbacks that should be considered in future studies. This article also discusses the implications of the results obtained and proposes directions for future research.
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Torres JAC, Cangas AJ, García GR, Langer ÁI, Zárate R. Early Detection of Drug Use and Bullying in Secondary School Children by Using a Three-Dimensional Simulation Program. CYBERPSYCHOLOGY BEHAVIOR AND SOCIAL NETWORKING 2012; 15:43-9. [DOI: 10.1089/cyber.2010.0589] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Affiliation(s)
- José A. Carmona Torres
- Department of Personality, Assessment and Psychological Treatment, University of Almeria, Almeria, Spain
| | - Adolfo J. Cangas
- Department of Personality, Assessment and Psychological Treatment, University of Almeria, Almeria, Spain
| | - Gustavo R. García
- Department of Personality, Assessment and Psychological Treatment, University of Almeria, Almeria, Spain
| | - Álvaro I. Langer
- Department of Personality, Assessment and Psychological Treatment, University of Almeria, Almeria, Spain
| | - Roberto Zárate
- University of California Los Angeles (UCLA), Los Angeles, California
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Stewart AD, Klein S, Young J, Simpson S, Lee AJ, Harrild K, Crockett P, Benson PJ. Body image, shape, and volumetric assessments using 3D whole body laser scanning and 2D digital photography in females with a diagnosed eating disorder: Preliminary novel findings. Br J Psychol 2011; 103:183-202. [DOI: 10.1111/j.2044-8295.2011.02063.x] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022]
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Abstract
PURPOSE OF REVIEW To examine techniques that have been used to assess various aspects of body-image perception and body-image attitudes in obesity. It summarizes findings from previous review articles and reports on new research findings that have been published between August 2007 and August 2010. RECENT FINDINGS Body-image perception and attitudes in obesity have been assessed using questionnaires, figural drawing scales and computer morphing or adjustment programs. Most of these techniques have been developed to assess body image in eating disorders and as such are not specific to the assessment of body image in obesity. SUMMARY Body-image perception and body-image attitudes are commonly assessed in research studies on obesity. However, currently available assessment instruments have not been developed specifically for use in obese populations and not all have been validated in these populations. Researchers should be careful in selecting assessment instruments that are appropriate for use in obesity.
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